Effects of left ventricular assist device on pulmonary functions and pulmonary hemodynamics: A meta-analysis

BACKGROUND: Given current evidence, the effect of left ventricular assist device (LVAD) implantation on pulmonary function tests remains controversial. AIM: To better understand the factors contributing to the changes seen on pulmonary function testing and the correlation with pulmonary hemodynamics after LVAD implantation. METHODS: Electronic databases were queried to identify relevant articles. The summary effect size was estimated as a difference of overall means and standard deviation on a random-effects model. RESULTS: A total of four studies comprising 219 patients were included. The overall mean forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and diffusion lung capacity of carbon monoxide (DLCO) after LVAD implantation were significantly lower by 0.23 L (95%CI: 0.11-0.34, P = 00002), 0.18 L (95%CI: 0.03-0.34, P = 0.02), and 3.16 mmol/min (95%CI: 2.17-4.14, P \u3c 0.00001), respectively. The net post-LVAD mean value of the cardiac index was significantly higher by 0.49 L/min/m2 (95%CI: 0.31-0.66, P \u3c 0.00001) compared to pre-LVAD value. The pulmonary capillary wedge pressure and pulmonary vascular resistance were significantly reduced after LVAD implantation by 8.56 mmHg (95%CI: 3.78-13.35, P = 0.0004), and 0.83 Woods U (95%CI: 0.11-1.55, P = 0.02), respectively. There was no significant difference observed in the right atrial pressure after LVAD implantation (0.61 mmHg, 95%CI: -2.00 to 3.32, P = 0.65). Overall findings appear to be driven by studies using HeartMateII devices. CONCLUSION: LVAD implantation might be associated with a significant reduction of the spirometric measures, including FEV1, FVC, and DLCO, and an overall improvement of pulmonary hemodynamics

Cost-effectiveness and diagnostic accuracy of telemedicine in macular disease and diabetic retinopathy: A systematic review and meta-analysis.

OBJECTIVE: To determine cost-effectiveness and the diagnostic accuracy of teleophthalmology (TO) in the detection of macular edema (ME) and various grades of diabetic retinopathy (DR). METHODS: MEDLINE, EMBASE, and Cochrane databases were searched for TO, ME, and DR on May 25, 2016. The search was updated on April 2, 2019. Pooled sensitivity and specificity for ME and various grades of DR were determined using Meta-Disc software. A systematic review of the articles discussing the cost-effectiveness of TO screening was also performed. RESULTS: Thirty-three articles on the diagnostic accuracy and 28 articles on the cost-effectiveness were selected. CONCLUSIONS: Telescreening is moderately sensitive but very specific for the diagnosis of diabetic retinopathy. Non-mydriatic Teleretinal screening services are cost-effective, decrease clinics workload, and increase patient compliance if provided free of cost in remote low socioeconomic regions

Comparative accuracy of non-invasive imaging versus right heart catheterization for the diagnosis of pulmonary hypertension: A systematic review and meta-analysis.

Background: Right heart catheterization (RHC) is the gold-standard in the diagnosis of pulmonary hypertension (PH) but at the cost of procedure-related complications. We sought to determine the comparative accuracy of RHC versus non-invasive imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and transthoracic echocardiography (TTE). Methods: Pulmonary hypertension was defined as a mean pulmonary artery pressure (mPAP) of\u3e20 mmHg. Multiple databases were queried for relevant articles. Raw data were pooled using a bivariate model to calculate the measures of diagnostic accuracy and to estimate Hierarchical Summary Receiver Operating Characteristic (HSROC) on Stata 13. Results: A total of 51 studies with a total patient population of 3947 were selected. The pooled sensitivity and specificity of MRI for diagnosing PH was 0.92(95% confidence interval (CI) 0.88-0.96) and 0.86 (95% CI, 0.77-0.95), respectively. The net sensitivities for CT scan and TTE were 0.79 (95% CI 0.72-0.89) and 0.85 (95% CI 0.83-0.91), respectively. The overall specificity was 0.82 (0.76-0.92) for the CT scan and 0.71 (95% CI 0.61-0.84) for TTE. The diagnostic odds ratio (DOR) for MRI was 124 (95% CI 36-433) compared to 30 (95% CI 11-78) and 24 (95% 11-38) for CT scan and TTE, respectively. Chi-squared ( Conclusions: MRI has the highest sensitivity and specificity compared to CT and TTE. MRI can potentially serve as a surrogate technique to RHC for the diagnosis of PH

Can leptonic mixing matrix have a Wolfenstein form?

Abstract We analyze the possibility of the leptonic mixing matrix having a Wolfenstein form at the Grand Unified Theory scale. The renormalization group evolution of masses and mixing angles from the high scale to electroweak scale, in certain new physics scenarios, can significantly alter the form of the leptonic mixing matrix. In the past it was shown that such significant enhancement implies that the leptonic mixing matrix at high scale can be the same or similar in structure to the quark one. We thoroughly analyze this hypothesis in the light of the latest neutrino oscillation data as well as other constraints such as those coming from neutrinoless double beta decay. We show that such an ansatz, at least within the context of minimal supersymmetric models, is no longer compatible with the latest experimental data

Gd(III) metal-organic framework as an effective humidity sensor and its hydrogen adsorption properties

Metal-organic frameworks (MOFs) represent a class of nanoporous materials built up by metal ions and organic linkers with several interesting potential applications. The present study described the synthesis and characterization of Gd(III)-based MOF with the chemical composition [Gd(BTC)(H$_2$O)]·DMF (BTC – trimesate, DMF = N,N′-dimethylformamide), known as MOF-76(Gd) for hydrogen adsorption/desorption capacity and humidity sensing applications. The structure and morphology of as-synthesized material were studied using powder X-ray diffraction, scanning and transmission electron microscopy. The crystal structure of MOF-76(Gd) consists of gadolinium (III) and benzene-1,3,5-tricarboxylate ions, one coordinated aqua ligand and one crystallization DMF molecule. The polymeric framework of MOF-76(Gd) contains 1D sinusoidally shaped channels with sizes of 6.7 × 6.7 Å propagating along c crystallographic axis. The thermogravimetric analysis, heating infrared spectroscopy and in-situ heating powder X-ray diffraction experiments of the prepared framework exhibited thermal stability up to 550 °C. Nitrogen adsorption/desorption measurement at −196 °C showed a BET surface area of 605 m$^2$ g$^{−1}$ and pore volume of 0.24 cm$^3$ g$^{−1}$. The maximal hydrogen storage capacity of MOF-76(Gd) was 1.66 wt % and 1.34 wt % −196 °C and −186 °C and pressure up to 1 bar, respectively. Finally, the humidity sensing measurements (water adsorption experiments) were performed, and the results indicate that MOF-76(Gd) is a suitable material for moisture sensing application with a fast response (11 s) and recovery time (2 s) in the relative humidity range of 11–98%

Frontline Science: HIV infection of Kupffer cells results in an amplified proinflammatory response to LPS

End-stage liver disease is a common cause of non-AIDS-related mortality in HIV patients, despite effective anti-retroviral therapies (ARTs). HIV-1 infection causes gut CD4 depletion and is thought to contribute to increased gut permeability, bacterial translocation, and immune activation. Microbial products drain from the gut into the liver via the portal vein where Kupffer cells (KCs), the resident liver macrophage, clear translocated microbial products. As bacterial translocation is implicated in fibrogenesis in HIV patients through unclear mechanisms, we tested the hypothesis that HIV infection of KCs alters their response to LPS in a TLR4-dependent manner. We showed that HIV-1 productively infected KCs, enhanced cell-surface TLR4 and CD14 expression, and increased IL-6 and TNF-α expression, which was blocked by a small molecule TLR4 inhibitor. Our study demonstrated that HIV infection sensitizes KCs to the proinflammatory effects of LPS in a TLR4-dependent manner. These findings suggest that HIV-1-infected KCs and their dysregulated innate immune response to LPS may play a role in hepatic inflammation and fibrosis and represent a novel target for therapy

META-ANALYSIS OF SAFETY AND EFFICACY OF RENIN ANGIOTENSIN ALDOSTERONE SYSTEM INHIBITORS IN COVID-19 POPULATION

BackgroundThe safety and efficacy of Renin Angiotensin Aldosterone System Inhibitors(RAASi) in COVID 19 patients has been controversial.MethodsDigital databases were queried for relevant articles. A random-effect model was used to compute an unadjusted odds ratio (OR).ResultsA total of 49 studies were included in the analysis yielding 82,610 COVID-19 patients (RAASi n=34357; No RAASi n=48253). The mean age was 64 years old and 57% of the sample was male. RAASi has similar mortality outcomes as compared to the non-RAASi group (OR-1.07; 95% CI: 0.74-1.15; p-0.08) (Figure 1). Significant improvements in seroconversion, including negative RT-PCR was found with RAASi (OR-0.96; 95% CI 0.93-0.99; p-0.02). Patients with RAASi can have higher in-hospital admission requirements (OR-1.12; 95% CI 1.04-1.21; p-0.004). We also found non-significant associations of RAASi with improvement in progression to ICU admission (OR- 0.99; 95% CI 0.79-1.23; p-0.9) and higher odds of worsening of clinical manifestations (OR-1.04; 95% CI 0.97-1.11; p-0.2) as compared to the absence of RAASi (Figure 1).ConclusionRAASi could be considered safe in patients with COVID-19. A continuation of RAASi can bring favorable outcomes including seropositivity/viral clearance and less inpatient hospitalization